Kinder, gentler initiation

“Thrown to the wolves” is how many nurses remember the transition from school to their first hospital job.

“That’s how I felt when I started nursing 13 years ago. The attitude was, ‘You went to nursing school; you ought to be able to do med/surg,’ ” said Lisa Pugsley, RN, BS, BSN, MSN, clinical education coordinator for the nurse residency program at Gwinnett Medical Center.

“It was very intimidating and difficult to ask an experienced nurse for help. You didn’t want to ask a dumb question. Oh yeah, I thought about quitting.”

Pugsley tells her story to every class that goes through the nurse residency program at Gwinnett Medical Center, which she has coordinated for two years. The health care system accepts 25 to 30 new graduates into the program twice a year.

“We don’t hire new grads without putting them through a 12- to 16-week residency program, depending on their specialty,” she said.

The new hires take classes together and work individually with clinical preceptors on their units.

“Nursing school is a generalist education. They need this training to learn their specialties,” Pugsley said.

Not every hospital has a nurse residency program. It’s expensive to employ new nurses who don’t carry a full caseload right away, and it ties up staff members who teach in the programs.

“The program is costly in its initial phases, but if you don’t have a residency program it can be even more costly in terms of retention,” Pugsley said. “If you don’t take care of new grads, they leave. Statistics show that between 30 [percent] to 60 percent of new nurses leave their first job within a year.”

Pugsley is confident the residency program prepares and supports nurses better than when she started her career.

“One hundred percent of the August 2009 class is still here and 14 of our new grads just received the hospital’s Rising Star Awards for Clinical Excellence,” she said.

Pugsley has equipped nurse residents to face down the wolves.

“It’s still scary, that first night when your name is the only one on a patient’s board,” said Ashley Fennessey, BSN, RN, an intensive care nurse who went through Gwinnett Medical Center’s residency program in 2009. “But this was a wonderful program. I know what knowledge base is expected by my hospital and I’ve formed friendships with other nurses just starting out, and had older nurses tell me I can make it.”

After working for six months, Fennessey still learns something new every week, but she has colleagues she can lean on when issues arise.

“Nursing is so much more than I expected, and I’m excited to come to work every day,” she said.

Laura Bennett, RN, BSN, who graduated from the Georgia Baptist College of Nursing of Mercer University in December, is grateful to be a nurse resident in the emergency department.

“I always wanted to work in the emergency room, but I can’t imagine just starting out on your own,” Bennett said. “This program allows you to build your self-confidence and self-esteem. It gives you such a good foundation for your career.”

The training has allowed Bennett to learn best practices from teachers, preceptors and mentors, and to make them her own.

“Patients lives are in our hands, and Gwinnett is preparing us to become top-notch nurses,” she said.

With nursing schools facing tight resources and faculty shortages, some students graduate with less clinical experience than in previous years, said Jan Gannon, vice president of patient care services at DeKalb Medical in Decatur. “When they go from having one or two patients in a clinical rotation to having five or six in a med/surg unit, they experience reality shock.”

Nurse residency programs can help bridge the clinical experience gap.

In its fourth year, DeKalb Medical’s nurse residency program accepts 20 to 30 graduates a year for the August-to-May program.

“It’s a big educator commitment and [it’s] very expensive to run, but worth it in terms of retention,” Gannon said. “It costs $45,000 to $60,000 to attract and train a new nurse, so we don’t want them to feel isolated, scared or burned out. We want happy nurses.”

Each orientation is tailored to the individual and the unit where that nurse will work. New nurses take general skills and specialty classes, and they work one-on-one with preceptors in their units. Social interaction to promote bonding is also a component of the program.

“The mix of learning, work, fun and nurses being supportive of each other is a great formula, and we’re proud of the results,” Gannon said. “New grads are some of our best nurses, and our retention rate is well above the national average.”

The national turnover rate for first-year nurses is about 27 percent, according to the PricewaterhouseCoopers Health Research Institute.

Phyllis Telesford, MA, CNS, RN, BSN, clinical education manager at DeKalb Medical, attributes the program’s success to an enthusiastic team of clinical educators and a willingness to embrace the nondidactic part of the program, which she calls the CARE-Packet.

“We welcome new grads with a reception, introduce them to staff and then we have a check-in day once every two weeks, where they can share their challenges and learn new skills,” she said.

A nurse for almost 30 years, Telesford believes nursing is more than a job, and that it can weigh heavily on rookies.

“We have all-day retreats and learning lunches, covering topics such as money management, exercise and how to be assertive without being aggressive,” Telesford said. “We give them a safe place to cry, bare their souls and talk about the personality clashes and other rights of passage they’re experiencing in their units.

“They need to know that they’re not the only one. Others have gone through it and successfully made the transition to professional. The CARE-Packet holds us together as family.”

Dave Franks, who became a nurse after serving in the Marine Corps and working as a surgical technician, said going through the residency program helped him.